<?php
    get_header();
?>
        <div class="row-fluid">
            <div class="span8 content-sidebar">
                <div class="row-fluid submitcode contact-us">
                    <div class="row-fluid title header-coupon">
                        <h1>Contact Us</h1>
                    </div>
                            <div class="row-fluid from-add-cp">
                                <form id="contact" name="form_contact" method="post" enctype="multipart/form-data">
                                    <div class="insert_err hiden">
                                        <p>**Sorry, your feed back not submit success! Please try again!</p>
                                    </div>
                                    <div class="insert_success hiden">
                                        <p>Thank you! <a href="<?php echo cpx_current_url();?>" title="send feedback">send again</a> </p>
                                    </div>
                                    <div class="row-fluid">
                                        <label>Your name<span class="requir">*</span></label>
                                        <input class="website" type="text" placeholder="Enter your name" 
                                           autocomplete="off" name="txt_yourname" value="<?php echo $_POST['txt_yourname'];?>" />
                                    </div>
                                    <div class="row-fluid">
                                        <label>Your email<span class="requir">*</span><span class="hiden email_not_valid_contact">* Email is not valid</span></label>
                                        <input class="entercode" type="email" placeholder="Enter your email address"  autocomplete="off" 
                                               name="txt_email_contact" value="<?php echo $_POST['txt_email_contact'];?>" />
                                    </div>
                                    <div class="row-fluid">
                                        <label>Title Feedback<span class="requir">*</span></label>
                                        <input class="entercode" type="text" placeholder="Enter title"  autocomplete="off" 
                                               name="txt_title" value="<?php echo $_POST['txt_title'];?>" />
                                    </div>
                                    <div class="row-fluid">
                                        <label>Feed back<span class="requir">*</span>:</label>
                                        <textarea name="txt_content_contact" placeholder="Your content"></textarea>
                                    </div>
                                    <div class="row-fluid wrap-captcha security">
                                        <img class="captcha_code" src="<?php echo get_template_directory_uri().'/inc/ajax-cp/cap/captcha_code_file.php'; ?>" alt="captcha"/>
                                    </div>
                                    <div class="row-fluid push_security">
                                        <label>Please type the word above<span class="requir">*</span> :</label>
                                        <input class="word" id="security_code" placeholder="Security Code" autocomplete="off" name="txt_captcha" type="text" />
                                        <div class="warming hiden captcha-missing">*Enter Security code</div>
                                        <div class="warming hiden captcha-check-fail">*Security code not match</div>
                                    </div>
                                    <div class="row-fluid submit_coupon">
                                        <input id="send_feedback" type="submit" name="send_feedback" value="Send Feedback"/>
                                    </div>
                                </form>
                            </div>
                </div>
            </div>
            <div class="span4 right-sidebar">
                    <?php if(is_active_sidebar('cs-main-sidebar')) dynamic_sidebar( 'cs-main-sidebar' ); ?>
            </div>
        </div>
        <div class="row-fluid top-store-category">
               <?php if(is_active_sidebar('cs-text-link-sidebar')) dynamic_sidebar( 'cs-text-link-sidebar' ); ?>
        </div>
<?php get_footer(); ?>
